Provider Demographics
NPI:1952455529
Name:STAFFORD, PARRIS MINOR (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PARRIS
Middle Name:MINOR
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 SOWERS RD NE
Mailing Address - Street 2:
Mailing Address - City:FLOYD
Mailing Address - State:VA
Mailing Address - Zip Code:24091-2076
Mailing Address - Country:US
Mailing Address - Phone:540-651-8154
Mailing Address - Fax:
Practice Address - Street 1:636 SOWERS RD NE
Practice Address - Street 2:
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-2076
Practice Address - Country:US
Practice Address - Phone:540-651-8154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA89196661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8919666Medicaid